Provider Demographics
NPI:1356913446
Name:QUICKMED DIAGNOSTIC INC.
Entity type:Organization
Organization Name:QUICKMED DIAGNOSTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SAVVIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-905-6441
Mailing Address - Street 1:7600 LEESBURG PIKE STE 110
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2004
Mailing Address - Country:US
Mailing Address - Phone:571-534-3973
Mailing Address - Fax:571-470-8259
Practice Address - Street 1:7600 LEESBURG PIKE STE 110
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2004
Practice Address - Country:US
Practice Address - Phone:571-534-3973
Practice Address - Fax:571-470-8259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUICKMED DIAGNOSTIC INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-16
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30015305430002Medicaid
VA49D2231959OtherCLIA ID